Prevalence and target attainment of traditional cardiovascular risk factors in patients with systemic lupus erythematosus: a cross-sectional study including 3401 individuals from 24 countries

BACKGROUND

Systemic lupus erythematosus (SLE) is characterised by increased cardiovascular morbidity and mortality risk. We aimed to examine the prevalence of traditional cardiovascular risk factors and their control in an international survey of patients with systemic lupus erythematosus.

METHODS

In this multicentre, cross-sectional study, cardiovascular risk factor data from medical files of adult patients (aged ≥18) with SLE followed between Jan 1, 2015, and Jan 1, 2020, were collected from 24 countries, across five continents. We assessed the prevalence and target attainment of cardiovascular risk factors and examined potential differences by country income level and antiphospholipid syndrome coexistence. We used the Systemic Coronary Risk Evaluation algorithm for cardiovascular risk estimation, and the European Society of Cardiology guidelines for assessing cardiovascular risk factor target attainment. People with lived experience were not involved in the research or writing process.

FINDINGS

3401 patients with SLE were included in the study. The median age was 43·0 years (IQR 33-54), 3047 (89·7%) of 3396 patients were women, 349 (10.3%) were men, and 1629 (48·1%) of 3390 were White. 556 (20·7%) of 2681 patients had concomitant antiphospholipid syndrome. We found a high cardiovascular risk factor prevalence (hypertension 1210 [35·6%] of 3398 patients, obesity 751 [23·7%] of 3169 patients, and hyperlipidaemia 650 [19·8%] of 3279 patients), and suboptimal control of modifiable cardiovascular risk factors (blood pressure [target of <130/80 mm Hg], BMI, and lipids) in the entire SLE group. Higher prevalence of cardiovascular risk factors but a better blood pressure (target of <130/80 mm Hg; 54·9% [1170 of 2132 patients] vs 46·8% [519 of 1109 patients]; p<0·0001), and lipid control (75·0% [895 of 1194 patients] vs 51·4% [386 of 751 patients], p<0·0001 for high-density lipoprotein [HDL]; 66·4% [769 of 1158 patients] vs 60·8% [453 of 745 patients], p=0·013 for non-HDL; 80·9% [1017 of 1257 patients] vs 61·4% [486 of 792 patients], p<0·0001 for triglycerides]) was observed in patients from high-income versus those from middle-income countries. Patients with SLE with antiphospholipid syndrome had a higher prevalence of modifiable cardiovascular risk factors, and significantly lower attainment of BMI and lipid targets (for low-density lipoprotein and non-HDL) than patients with SLE without antiphospholipid syndrome.

INTERPRETATION

High prevalence and inadequate cardiovascular risk factor control were observed in a large multicentre and multiethnic SLE cohort, especially among patients from middle-income compared with high-income countries and among those with coexistent antiphospholipid syndrome. Increased awareness of cardiovascular disease risk in SLE, especially in the above subgroups, is urgently warranted.

FUNDING

None.

Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis

BACKGROUND

Immunosuppressive (IS) agents are recommended for the first-line treatment of patients with active Takayasu's arteritis (TAK) together with glucocorticoids (GCs). However, there is limited data comparing the efficacy and outcomes of different IS agents for this purpose.

OBJECTIVES

In this study, we aimed to compare the outcomes of two most frequently used first-line IS agents, namely methotrexate (MTX) and azathioprine (AZA) in TAK patients.

METHODS

TAK patients who received any IS agent in addition to GCs as the initial therapy were included in this multicentre, retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a matched analysis (cc match) using variables 'age', 'gender' and 'diffuse aortic involvement' was performed between patients who received MTX or AZA as the first-line IS treatment.

RESULTS

We recruited 301 patients (F/M: 260/41, mean age: 42.2 ± 13.3 years) from 10 tertiary centres. As the first-line IS agent, 204 (67.8 %) patients received MTX, and 77 (25.6 %) received AZA. Less frequently used IS agents included cyclophosphamide in 17 (5.6 %), leflunomide in 2 (0.5 %) and mycophenolate mofetil in one patient. The remission, relapse, radiographic progression and adverse effect rates were similar between patients who received MTX and AZA as the first-line IS agent. Vascular surgery rate was significantly higher in the AZA group (23% vs. 9 %, p = 0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was significantly higher in the MTX group (76% vs 62 %, p = 0.034). Similarly, the rate of vascular surgery was higher in AZA group in matched analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42 %, p = 0.34). IS therapy was discontinued in 18 (12 MTX, 6 AZA) patients during the follow-up period due to remission. Among those patients, two patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of a mean 69.4 (±50.9) months of follow-up.

CONCLUSIONS

Remission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.

Divergent perspectives: exploring the relationships between St. George's Respiratory Questionnaire and outcome measures in systemic sclerosis-associated interstitial lung disease

INTRODUCTION/OBJECTIVES

Controversy exists regarding the concordance of patient-reported outcome measures (PROMs) with other assessment parameters in systemic sclerosis-associated interstitial lung disease (SSc-ILD). This study aims to explore the association between the St. George's Respiratory Questionnaire (SGRQ) and various outcome measures in patients with SSc-ILD within a real-world cross-sectional setting.

METHOD

Patients with SSc-ILD were consecutively recruited from our SSc cohort. Simultaneous administration of SGRQ, scleroderma Health Assessment Questionnaire (sHAQ), respiratory visual analog scale (R-VAS), pulmonary function tests (PFTs), and the 6-min walking test (6-MWT) was conducted. The total extent of lung fibrosis was quantified using high-resolution computed tomography (HRCT) images. Relationships between SGRQ and functional, radiographic, and other patient-reported outcome measures were analyzed.

RESULTS

The total SGRQ score demonstrated correlations with forced vital capacity (FVC) and R-VAS (r =  - 0.397, p = 0.016 and r = 0.418, p = 0.027, respectively). Symptom score correlated with ILD-extension (r = 0.430, p = 0.005); activity score correlated with FVC and R-VAS (r =  - 0.502, p = 0.002 and r = 0.395, p = 0.038, respectively); impact score correlated with R-VAS (r = 0.386, p = 0.043). In patients with fibrosis extent exceeding 20%, total SGRQ score was associated with sHAQ and R-VAS (r = 0.398, p = 0.049; r = 0.524, p = 0.021, respectively), activity score with R-VAS (r = 0.478, p = 0.038), and impact score with 6-MWT-D and R-VAS (r =  - 0.489, p = 0.034; r = 0.545, p = 0.016, respectively). The symptom score and activity score demonstrated optimal performance in identifying patients with interstitial lung disease (ILD) extent exceeding 20% and forced vital capacity (FVC) less than 70% (area under the curve [AUC] 0.799, p = 0.002, and AUC 0.792, p = 0.03, respectively).

CONCLUSIONS

Our study reveals varying degrees of correlation between SGRQ and distinct outcome measures. Given the incomplete alignment of SGRQ with other outcome measures, an integrative approach utilizing existing criteria as complementary tools is recommended. Key Points • Patient-reported outcome measures (PROMs) derive from patients' subjective evaluations of the impact of the disease on their daily activities, social interactions, and psychological well-being. • PROMs frequently serve as outcome measures in randomized controlled trials, yet conflicting findings have emerged in relation to primary outcomes. • This study aims to assess the appropriateness and interrelation of PROMs with both radiological and functional outcome measures, providing insight into the current state of our patients in a real-life context. The investigation delves into the compatibility of these measures with each other.

Characteristics and outcome of ANCA-associated vasculitides induced by anti-thyroid drugs: a multicentre retrospective case-control study

OBJECTIVE

Data on ANCA-associated vasculitis (AAV) induced by anti-thyroid drugs (ATD) are scarce. We aimed to describe the characteristics and outcome of these patients in comparison to primary AAV.

METHODS

We performed a retrospective multicentre study including patients with ATD-induced AAV. We focused on ATD-induced microscopic polyangiitis (MPA) and compared them with primary MPA by matching each case with four controls by gender and year of diagnosis.

RESULTS

Forty-five patients with ATD-induced AAV of whom 24 MPA were included. ANCA were positive in 44 patients (98%), including myeloperoxidase (MPO)-ANCA in 21 (47%), proteinase 3 (PR3)-ANCA in six (13%), and double positive MPO- and PR3-ANCA in 15 (33%). Main clinical manifestations were skin involvement (64%), arthralgia (51%) and glomerulonephritis (20%). ATD was discontinued in 98% of cases, allowing vasculitis remission in seven (16%). All the remaining patients achieved remission after glucocorticoids, in combination with rituximab in 11 (30%) or cyclophosphamide in four (11%). ATD were reintroduced in seven cases (16%) without any subsequent relapse. Compared with 96 matched primary MPA, ATD-induced MPA were younger at diagnosis (48 vs 65 years, P < 0.001), had more frequent cutaneous involvement (54 vs 25%, P = 0.007), but less frequent kidney (38 vs 73%, P = 0.02), and a lower risk of relapse (adjusted HR 0.07; 95% CI 0.01, 0.65, P = 0.019).

CONCLUSION

ATD-induced AAV were mainly MPA with MPO-ANCA, but double MPO- and PR3-ANCA positivity was frequent. The most common manifestations were skin and musculoskeletal manifestations. ATD-induced MPA were less severe and showed a lower risk of relapse than primary MPA.

Low relapse rate in patients with giant cell arteritis in a multi-centre retrospective Turkish Registry

OBJECTIVES

Glucocorticoids (GC) are widely accepted as the standard first-line treatment for giant cell arteritis (GCA). However, relapse rates are reported up to 80% on GC-only protocol arms in controlled trials of tocilizumab and abatacept in 12-24 months. Herein, we aimed to assess the real-life relapse rates retrospectively in patients with GCA from Turkey.

METHODS

We assembled a retrospective cohort of patients with GCA diagnosed according to ACR 1990 criteria from tertiary rheumatology centres in Turkey. All clinical data were abstracted from medical records. Relapse was defined as any new manifestation or increased acutephase response leading to the change of the GC dose or use of a new therapeutic agent by the treating physician.

RESULTS

The study included 330 (F/M: 196/134) patients with GCA. The mean age at disease onset was 68.9±9 years. The most frequent symptom was headache. Polymyalgia rheumatica was also present in 81 (24.5%) patients. Elevation of acute phase reactants (ESR>50 mm/h or CRP>5 mg/l) was absent in 25 (7.6%) patients at diagnosis. Temporal artery biopsy was available in 241 (73%) patients, and 180 of them had positive histopathological findings for GCA. For remission induction, GC pulses (250-1000 methylprednisolone mg/3-7 days) were given to 69 (20.9%) patients, with further 0.5-1 mg/kg/day prednisolone continued in the whole group. Immunosuppressives as GC-sparing agents were used in 252 (76.4%) patients. During a follow-up of a median 26.5 (6-190) months, relapses occurred in 49 (18.8%) patients. No confounding factor was observed in relapse rates. GC treatment could be stopped in only 62 (23.8%) patients. Additionally, GC-related side effects developed in 64 (24.6%) patients, and 141 (66.2%) had at least one Vasculitis Damage Index (VDI) damage item present during follow-up.

CONCLUSIONS

In this first multi-centre series of GCA from Turkey, we observed that only one-fifth of patients had relapses during a mean follow-up of 26 months, with 76.4% given a GC-sparing IS agent at diagnosis. At the end of follow-up, GC-related side effects developed in one-fourth of patients. Our results suggest that patients with GCA had a low relapse rate in real-life experience of a multi-centre retrospective Turkish registry, however with a significant presence of GC-associated side effects during follow-up.

Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO Registry

OBJECTIVES

The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS).

METHODS

We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m2], overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated.

RESULTS

There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 ± 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P = .003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P > .05).

CONCLUSIONS

This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients.

Analysis of clinical, immunological characteristics, damage, and survival in 300 Turkish systemic lupus erythematosus patients

OBJECTIVE

This retrospective study aimed to conduct a comprehensive analysis of Turkish Systemic Lupus Erythematosus (SLE) patients of Caucasian ethnicity, focusing on their clinical, immunological, and therapeutic characteristics, damage accural and mortality.

PATIENTS AND METHODS

We carried out a retrospective assessment of 300 SLE patients diagnosed between 2001 and 2017 at Kocaeli University Rheumatology Clinic. Demographic data, clinical manifestations, immunological profiles, treatment approaches, disease-related damage, and survival information were collected.

RESULTS

The study population had a significant female predominance (89%) with a mean age of disease onset of 35.4 (SD:13.3) years. Hematological (72.6%) and mucocutaneous (72%) manifestations were the most common clinical findings, followed by arthritis (66.3%). Females had higher frequency of photosensitivity (p = 0.019), malar rash (p < 0.001), and alopecia (p = 0.014). Anti-dsDNA antibodies were detected in 61.6% of patients, while 57% of patients had hypocomplementemia. Secondary antiphospholipid syndrome was observed in 15.3% of patients; the most common manifestations included deep venous thrombosis (32.6%) and cerebrovascular accidents (30.4%). Lupus Nephritis (LN) affected 40.3% of the cohort. The most common pathologic finding was Class IV LN (30.5%). Eventually, 13 (4.3%) patients developed chronic kidney disease (CKD) and 4 had renal replacement therapies. Patients with LN had higher usage of pulse steroids, azathioprin, mycophenolate mofetil, cyclophosphamide, and rituximab (p < 0.001 for each).  In the juvenile-onset group (n = 31, 10.3%), an increased occurrence of malar rash (p = 0.009), nephritis (p = 0.034), hypocomplementemia (p = 0.001), positive anti-dsDNA (p = 0.007), anti-Sm (p = 0.046), anti-rib-P (p = 0.014) antibodies were observed. At least one damage parameter was observed in 32.6% patients with musculoskeletal manifestations being the most common. Thirteen patients were diagnosed with various malignancies, with cervical cancer being the most common (4 cases). The total 5 and 10-year survival rates were 92.5% and 86.7%, respectively. However, patients with CKD, had lower survival rates; 75% at 3 years and 60% at 15 years. Regression analysis demonstrated an association of CKD and  history of infections with decreased survival (p = 0.02, each).

CONCLUSION

Ethnicity and geography influence the clinical diversity of SLE. Recognizing these disparities is crucial for tailoring patient care. Future inception cohort studies in Turkish SLE patients are necessary to address the limitations of retrospective research.

Gynecological symptoms in primary and secondary Sjögren's syndrome and the effect of the disease on sexuality

BACKGROUND

Sjögren's syndrome (SS) is an autoimmune systemic disease affecting many organs and systems, such as genital system.

AIM

This study aimed to present the gynecological symptoms of patients who were followed up in an outpatient clinic because of primary Sjögren's syndrome (pSS) and secondary Sjögren's syndrome (sSS) and to show how the disease affected sexuality.

METHODS

This study is a cross-sectional study conducted between 2019 and 2020. The study sample consisted of 60 pSS patients, 42 sSS patients, and 52 healthy control subjects.

OUTCOMES

All the participants were questioned about sexuality, and completed the 36-item Short Form Survey, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, and Modified Hill questionnaire.

RESULTS

The patients had a mean age of 55.6 ± 11.85 years in pSS, 59.39 ± 11.18 years in sSS, and 56.1 ± 10.46 years in healthy control subjects. Vaginal and vulvar dryness and dyspareunia were present at a significantly higher rate in SS, especially in pSS, compared with the control subjects. The Health Assessment Questionnaire score was significantly lower in the pSS group than in the sSS group. Arthralgia, myalgia, and fatigue were prominent in all SS patients.

CLINICAL IMPLICATIONS

Gynecological symptoms, sexual ability, and the effects of the disease on sexuality should be questioned in all SS patients.

STRENGTHS AND LIMITATIONS

It is very important that we evaluate the gynecological symptoms of both pSS and sSS patients and the effect of the disease on these symptoms. The small number of patients and healthy control subjects is a limitation.

CONCLUSION

The gynecological and musculoskeletal symptoms negatively affected sexuality in patients with pSS and sSS, and the negative effect of the disease on sexuality was more pronounced in the pSS group.

Radiological progression and predictive factors in psoriatic arthritis: insights from a decade-long retrospective cohort study

OBJECTIVES

Radiological alterations in psoriatic arthritis (PsA) are an established phenomenon frequently observed throughout the disease course. Our goal was to investigate the changes in the bone structure of PsA patients by conventional radiography.

METHODS

This study designed as a retrospective cohort study and cross-sectional evaluation for disease activity. The disease activity and the severity of skin and nail involvement were assessed. The Simplified Psoriatic Arthritis Radiographic Score (SPARS) was used to investigate the radiological progression. Logistic regression analysis was used to determine the predictors of radiological changes.

RESULTS

Joint space narrowing and bone proliferation in hands (p = 0.001 and p = 0.001, respectively) and joint space narrowing in feet (p = 0.047) were more common at the final evaluation than at the baseline assessment. Total scores of joint space narrowing and bone proliferation in hands and feet were higher at the last visit than at the initial assessment (p < 0.001). Male gender (p = 0.030, OR 4.32 (95%CI 1.15-16.15)], older age (for joint space narrowing [p = 0.026 OR 1.08 (95%CI 1.01-1.56)] and for proliferation [p = 0.025 OR 1.08 (95%CI 1.01-1.44)]), high Disease Activity index for Psoriatic Arthritis (DAPSA) scores at baseline [p = 0.032 OR 6.21 (95%CI 1.17-32.92)], and symmetrical polyarticular involvement at baseline [p = 0.025 OR 5.3 (95% CI 1.23-22.4)] were found as predictors of structural changes.

CONCLUSION

By the end of the decade, joint space narrowing and proliferation were observed to be more common than erosion. Male gender, older age, higher initial DAPSA scores, and initial polyarticular involvement were identified as predictors of radiological damage. Key Points • The radiological changes of Psoriatic arthritis are a well-known entity. However, studies investigating the progression of joint involvement over time are scarce. • This study reveals that joint space narrowing and proliferation are the most prominent radiological alterations in Psoriatic Arthritis patients at the end of the decade. • Male gender, older age, higher baseline DAPSA scores, and initial polyarticular involvement are predictive factors influencing the progression of bone destruction  in Psoriatic Arthritis patients.

Atezolizumab-induced myositis in a patient with small-cell lung cancer

OBJECTIVE

Myositis, an inflammatory disease affecting muscles, is a rare and potentially fatal immune-related adverse event associated with immune checkpoint inhibitors. There are limited data on its clinical features and management.

CASE PRESENTATION

Atezolizumab, in combination with etoposide and carboplatin, was initiated in the patient diagnosed with metastatic small-cell lung cancer. After four cycles, maintenance atezolizumab was initiated. At the third visit of the maintenance therapy, the patient reported weakness, edema, and tightness in the muscles that had progressed over the course of a week. Mild solid-food dysphagia was also observed. Neutrophilic leukocytosis with elevated creatine phosphokinase (9234 U/L), erythrocyte sedimentation rate (111 mm/h), and transaminase levels were observed. A diagnosis of myositis was considered based on clinical findings. Atezolizumab was omitted and an oral 0.5 mg/kg/day dose of methylprednisolone was administered. The myositis resolved within 10 days. During the treatment of myositis, the patient underwent prophylactic cranial irradiation. The steroid dose was tapered off within 35 days and then atezolizumab was restarted.

CONCLUSION

The literature contains only a few case reports about atezolizumab-induced myositis, highlighting the challenges in defining its clinical features and management. Prompt diagnosis and treatment are crucial to prevent severe complications, such as myocarditis or respiratory muscle paralysis.

Long-term efficacy of canakinumab in hyperimmunoglobulin D syndrome

Hyperimmunoglobulin D syndrome (HIDS) is a rare autoinflammatory disorder with autosomal recessive inheritance. It is caused by specific mutations in the mevalonate kinase gene (MVK). No treatment specific to HIDS has been approved to date; however, nonsteroidal anti-inflammatory drugs, steroids, colchicine, tumor necrosis factor-α inhibitors, and anti-interleukin-1 treatments are used, based on case reports and observational studies. Herein, we report a case with recurrent fever and arthritis attacks who did not respond to anakinra and was successfully treated with canakinumab. Long-term remission was achieved without any side effects with 300 mg canakinumab treatment every 4 weeks for 5 years.

Disease severity and genotype-phenotype correlation in adult patients with familial Mediterranean fever

OBJECTIVES

To assess the relationships of disease severity with genotype and phenotype in adult familial Mediterranean fever patients.

METHODS

Two-hundred seventy-five patients included in the study were divided into four groups according to their mutations: Group 1, M694V homozygous; Group 2, M694V-other; Group 3, other-other; and Group 4, no meaningful gene variants. Disease severity was evaluated using the Pras disease severity score. The association between Pras scores and other possible predictors was assessed by the multiple linear regression analysis.

RESULTS

In this study, 12.4% of all patients were in Group 1, 55.3% were in Group 2, 26.5% were in Group 3, and 5.8% were in Group 4. Pras scores were higher in Group 1 than in Groups 2, 3, and 4 (post hoc pairwise comparisons; P = .001, P < .001, and P = .001, respectively). Age at disease onset and age at diagnosis were found moderately and strongly correlated with Pras scores. Patients with moderate and severe disease were intensely involved in Group 1.

CONCLUSIONS

Higher Pras scores, earlier age of symptoms and diagnosis, more frequent arthritis and erysipelas-like erythema, and higher colchicine dose are closely associated with M694V homozygous familial Mediterranean fever patients. These patients also have mostly moderate and severe disease severity.

Unintentional Monotherapy in Rheumatoid Arthritis Patients Receiving Tofacitinib and Drug Survival Rate of Tofacitinib

OBJECTIVE

To determine the rate of unintentional monotherapy (UM; switching to monotherapy from combination therapy of patients' own volition) in rheumatoid arthritis patients receiving tofacitinib and to evaluate tofacitinib survival rate.

METHODS

This national, multicenter study included patients' data from the TURKBIO Registry. Demographics, clinical characteristics, disease duration and activity, comorbidities, and treatments were analyzed.

RESULTS

Data of 231 rheumatoid arthritis patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy on their own volition (UM); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The rate of comorbidities at the time of data retrieval was higher in the UM group than in the combination group (83.3% vs. 60.3%, p = 0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy ( p = 0.039; odds ratio, 3.29; 95% confidence interval, 1.06-10.18). The combination and UM groups did not differ regarding remission rate assessed by Disease Activity Score 28-joint count C-reactive protein (60.5% and 70%, respectively; p = 0.328). Drug survival rates of the UM and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with 1- and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the UM group.

CONCLUSIONS

Although 13.4% of the study population started monotherapy unintentionally, drug survival and remission rates of the UM and combination groups were not different. Comorbidity was a factor affecting transition from combination therapy to monotherapy.

Extended autoantibody panel in Turkish patients with early-stage systemic sclerosis: Coexpressions and their influences on clinical phenotypes

BACKGROUND/AIM

To investigate the frequency and clinical relevance of an extended autoantibody profile in patients with systemic sclerosis (SSc).

MATERIALS AND METHODS

In this cross-sectional study, serum from 100 consecutive patients was subjected to indirect immunofluorescence (IIF) (HEp-20-10/primate liver mosaic) and Systemic Sclerosis Profile by EUROIMMUN to evaluate anti-nuclear antibodies (ANA) and autoantibodies against 13 different autoantibodies in patients with SSc less than 3 years.

RESULTS

Ninety-three of 100 patients were positive for ANA by IIF. Fifty-three patients showed single positivity, 26 anti-topoisomerase antibodies (anti-Scl70 ab), 16 anticentromere antibodies (ACAs), six anti-RNA polymerase III antibodies (anti-RNAPIII ab), one anti-Ku antibody, one anti-PM/Scl100 antibody, two anti-PM/Scl75 antibodies, one anti-Ro52 antibody, whereas 32 patients had multiple autoantibody positivities. Among classic SSc-specific autoantibodies, anti-Scl70 and anti-RNAPIII abs showed the highest cooccurrence (n = 4). One patient was simultaneously positive for anti-RNAPIII ab and ACA, and one was positive for ACA and anti-Scl70 ab. The clinical features were not statistically different between single and multiple autoantibody-positivity for classic SSc-specific autoantibodies (ACA, anti-Scl70 ab, and anti-RNAPIII ab), except for digital ulcer in the multiantibody positive ACA group (p = .019).

CONCLUSION

Based on our results, coexpression of autoantibodies is not uncommon in SSc patients. Although autoantibodies specific to SSc in early disease show generally known clinical features, it remains to be investigated how the coexpression of autoantibodies will affect clinical presentation.

Sex-specific analysis in Behçet's disease reveals higher genetic risk in male patients

OBJECTIVES

Behçet's disease tends to be more severe in men than women. This study was undertaken to investigate sex-specific genetic effects in Behçet's disease.

METHODS

A total of 1762 male and 1216 female patients with Behçet's disease from six diverse populations were studied, with the majority of patients of Turkish origin. Genotyping was performed using an Infinium ImmunoArray-24 BeadChip, or extracted from available genotyping data. Following imputation and extensive quality control measures, genome-wide association analysis was performed comparing male to female patients in the Turkish cohort, followed by a meta-analysis of significant results in all six populations. In addition, a weighted genetic risk score for Behçet's disease was calculated and compared between male and female patients.

RESULTS

Genetic association analysis comparing male to female patients with Behçet's disease from Turkey revealed an association with male sex in HLA-B/MICA within the HLA region with a GWAS level of significance (rs2848712, OR = 1.46, P = 1.22 × 10-8). Meta-analysis of the effect in rs2848712 across six populations confirmed these results. Genetic risk score for Behçet's disease was significantly higher in male compared to female patients from Turkey. Higher genetic risk for Behçet's disease was observed in male patients in HLA-B/MICA (rs116799036, OR = 1.45, P = 1.95 × 10-8), HLA-C (rs12525170, OR = 1.46, P = 5.66 × 10-7), and KLRC4 (rs2617170, OR = 1.20, P = 0.019). In contrast, IFNGR1 (rs4896243, OR = 0.86, P = 0.011) was shown to confer higher genetic risk in female patients.

CONCLUSIONS

Male patients with Behçet's disease are characterized by higher genetic risk compared to female patients. This genetic difference, primarily derived from our Turkish cohort, is largely explained by risk within the HLA region. These data suggest that genetic factors might contribute to differences in disease presentation between men and women with Behçet's disease.

AB0665 Turkish validation of the ‘Cochin (Duruoz) hand function scale’ in patients with systemic sclerosis

Background

Hand impairment is the main challenge for patients with systemic sclerosis (SSc) and may arise from inflammatory arthritis, joint contractures, tendon friction rubs (TFRs), Raynaud’s phenomenon (RP), digital ulcers (DU), puffy hands, skin sclerosis, acro-osteolysis, or calcinosis. There is not yet a tool which can objectively measure hand functions in scleroderma patients both in daily practice and for research purposes.

Objectives

To adapt and validate the Turkish version of Cochin (Duruoz) hand function scale (CHFS) and contribute to the development of outcome measures with good metric properties assessing hand disability in SSc (1).

Methods

Ninety one consecutive patients who fulfilled the 2013 ACR/EULAR SSc classification criteria for SSc were enrolled in the study. Disease related involvements and physical examination findings of the patients were recorded. Participants filled out the self-administered questionnaire of the Turkish version of the CHFS. Modified Rodnan skin scores of the patients were calculated, bilateral hand extension and fingertip-palm distances were measured, grip strength was evaluated with hydrolic hand dynamometer. We evaluated convergent validity by testing the correlation between CHFS and related components of Short Form 36 version 2 (SF-36v2) and Scleroderma Health Assessment Questionnaire (sHAQ). Discriminant validity was evaluated by stratifying patients according to hand related involvements and disease subtypes. Thirty of the patients re-filled the CHFS questionnaire two weeks after the first visit.

Results

Demographic data and disease characteristics of the patients shown in Table 1. For the convergent validity, the CHFS significantly correlated with the sHAQ, Raynaud visual analog scale (VAS), digital ulser VAS, overall disease severity VAS, hand grip, hand extension measurements and fingertip-palm distances (Table 2). The instruments could discriminate between disease subtypes (10[0-24] / 2[0-19], p=0,038) and between the patients with and without contractures (11[0-24] / 2[0-9], p=0,023) for the discriminant validity. We demonstrated high reproducibility for CHFS (ICC = 0,894, 95% confidence interval = 0,779-0,949).

Table 1.

Demographic data and disease characteristics of the patients

Age (years)55.4±10.7Total mRSS6 ±5.1Sex (female)79 (%86.8)Right hand total mRSS2.2±1.7Diseasesubtype (diffuse)25(%27.5)Left hand total mRSS2.2±1.7PAH6 (%6.7)Right hand fingertip-palm distance (cm)1.3±1ILD41 (%45.6)Left hand fingertip-palm distance (cm)1.2±1.2ANA positivity88 (%96.7)Right hand extension (cm)17.7±2.5Arthritis1 (%1.1)Left hand extension (cm)18±2.3Sclerodactly79 (%86.8)Right hand hydrolic dynomometer pressure (kg)21.7±8.6Contracture26 (%28.6)Left hand hydrolic dynomometer pressure (kg)20.4±7.6Amputation12 (%13.2)SF 36 physical function51.7 ±24Active digitalulcer3 (%3.2)SF 36 role limitations due to physical health52±42Digitalulcerscar23 (%25.3)SF 36 role limitations due to emotional problems57.3±33.4Calcinosis10 (%11)SF 36 energy/fatigue46±23.3CHFS score3 [0-13]SF 36 emotional well-being60.4±21.2Raynaud’s phenomenon VAS0.8±0.9SF 36 social functioning70±26Digital ulcer VAS0.5±0.9SF 36 pain64±30Overall disease severity VAS0.9±0.9SF 36 general health44.3±21.7

PAH: Pulmoner arterial hypertension, ILD: Interstitial lung disease, ANA: Anti nuclear antibody, CHFS: Cochin hand function scale, mRSS: Modified Rodnan skin score, VAS: visual analog scale, SF36: short form 36

Conclusion

The Turkish version of the CHFS met the requirements of validity and reproducibility. With this study, we validated a scale which will contribute to the development of outcome measures with good metric properties assessing hand disability, disease evolution and treatment efficacy in our SSc patients.

References

[1]Duruöz MT, Poiraudeau S, Fermanian J, et al. Development andvalidationof a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996;23(7):1167-1172.

Disclosure of Interests

None declared

AB0581 TRACHEAL STENOSIS; AN IMPORTANT INVOLVEMENT IN GRANULOMATOSIS WITH POLYANGIITIS

Background

Granulomatosis with polyangiitis (GPA) is a granulomatous systemic vasculitis of unknown etiology that can affect many organs. Approximately 90% of patients with GPA have upper respiratory tract involvement, including the nasal cavity, sinuses, ear and trachea. Subglottic stenosis (SGS) may develop in some patients due to tracheal involvement.

Objectives

It is aimed to evaluate the general characteristics, treatments and disease prognosis of our GPA cases with tracheal stenosis as it is a significant cause of morbidity and mortality.

Methods

The data of 48 patients diagnosed with GPA between 2000-2021 were analyzed retrospectively and the data of 6 patients with tracheal stenosis (TS) were evaluated.

Results

TS was present in 13% of the patients. All patients with TS were female. The mean age of the patients with TS was 46.5±6.5 years, the mean age of disease onset was 35.5 ±13.4 years, and the mean disease duration was 10.8±10.2 years. Constitutional symptoms were in 17% of patients, and 17% had mastoiditis, sinusitis, otitis, bloody nasal discharge and renal involvement. None of the patients had hearing loss, skin, eye and neurological involvement. 83% of patients had limited disease. While all patients had SGS, one patient also had glottic and bronchial stenosis. The most common symptoms in patients were hoarseness and shortness of breath. All patients received systemic treatment according to their organ involvement, local treatment (dilatation, steroid injection) was also applied to two patients. All patients had anti-neutrophil cytoplasmic antibody (ANCA) positivity. When patients with and without tracheal stenosis were compared, there was a difference in terms of gender, lung and kidney involvement, presence of anemia, increased erythrocyte sedimentation rate, pANCA, cANCA and PR3-ANCA positivity, and myalgia. In addition, our patients with tracheal stenosis had a younger age of onset and a longer delay in diagnosis.

Conclusion

The incidence of SGS in large series has been reported as 8-23% of GPA patients.1,2 Although the number of cases in our study was small, this rate was 13%. Symptoms range from cough and shortness of breath to progressively life-threatening severe stridor. Early diagnosis and treatment are important. For this reason, TS is strongly emphasized.

References

[1]Girard C, Charles P, Terrier B, Bussonne G, Cohen P, Pagnoux C, et al. Tracheobronchial stenoses in granulomatosis with polyangiitis (Wegener’s). Medicine. 2015;34:1-6.

[2]Costantino CL, Niles JL, Wright CD, Mathisen DJ, Muniappan A. Subglottic stenosis in granulomatosis with polyangiitis: therole of laryngotracheal resection. Ann Thorac Surg 2018;105:249-53.

Table 1.

Comparison of data from GPA patients with and without tracheal stenosis

N(%)Tracheal Stenosis +GPA(n=6)Tracheal Stenosis - GPA (n=42)PGender Female6 (100)21(51)0.031  Male020(49)Mean Age46.5±6.555.6±13.20.095Symptom Onset Age35.5±13.449.3±14.50.041Delay in Diagnosis (months)44.2±6.59.98±14.80.023Myalgia2(33)33(81)0.030Fever1(17)21(51)0.194High ESR1(17)31(78)0.007High CRP5(50)32(80)0.138Anemia1(17)28(70)0.020Upper Respiratory Involvement6(100)24(59)0.074Lung Involvement3(50)36(90)0.037GIS involvement1(17)6(15)1Eye Involvement-11(27)NASkin Involvement-12(29)NAUrogenital Involvement-1(2)NANeurological Involvement-13(32)NARenal Involvement1(17)29(71)0.018ANCA positivity6(100)38(93)1  MPO-ANCA2(33)4(10)0.162  PR3-ANCA1(17)33(81)0.004  p-ANCA5(83)6(15)0.000  c-ANCA1(17)31(78)0.001

Disclosure of Interests

None declared

AB0420 UNINTENTIONAL MONOTHERAPY IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING TOFACITINIB AND DRUG SURVIVAL RATE OF TOFACITINIB

Background

Combination of MTX with a bDMARDs or tsDMARDs is considered the most effective treatment regimen currently available for patients with RA who have failed to respond to conventional DMARDs. However, approximately 30% of patients receive bDMARDs as monotherapy in daily clinical practice. Studies in the literature do not assess unintentional monotherapy in general. However, it is thought that some patients may switch to monotherapy unintentionally. In other words, some patients who are prescribed combination therapy switch to monotherapy without informing their physicians.

Objectives

To determine the rate of unintentional monotherapy in rheumatoid arthritis (RA) patients receiving tofacitinib and to evaluate tofacitinib survival rate.

Methods

This national, multicentre, retrospective study included patients’ data from the TURKBIO Registry. Data on demographics, clinical characteristics, disease duration and activity, comorbidities, and treatment were analysed.

Results

Data of 231 RA patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy of their own will (unintentional monotherapy); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The combination and unintentional monotherapy groups did not differ regarding remission rate assessed by DAS28-CRP (60.5% and 70%, respectively, p=0.328). The rate of comorbidities at the time of data retrieval was significantly higher in the unintentional monotherapy group compared with the combination group (83.3% vs. 60.3%, p=0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy (p=0.039, Odds ratio: 3.29, 95% CI: 1.06-10.18). Drug survival rates of the unintentional monotherapy and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with a 1-year and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the unintentional monotherapy group.

Conclusion

Although 13.4% of the study population started monotherapy unintentionally, drug survival rates of the unintentional monotherapy and combination groups were not different. Comorbidity was an important factor affecting transition from combination therapy to monotherapy.

This study was sponsored by Pfizer.

Figure 1.

Disclosure of Interests

Nevsun Inanc: None declared, Kerem Abacar: None declared, mehmet akif ozturk: None declared, Abdurrahman Tufan: None declared, Hazan Karadeniz: None declared, İsmail Sari: None declared, gercek can: None declared, Yesim Erez: None declared, yavuz Pehlivan: None declared, Ediz Dalkiliç: None declared, Tuğba Ocak: None declared, Ayse Cefle: None declared, Ayten Yazici Grant/research support from: Ayten Yazici has received project grant from Roche Pharmaceuticals, Turkey., Abdurrahman Senel: None declared, Servet Akar: None declared, Elif Durak Ediboglu: None declared, Süleyman Serdar Koca: None declared, Rabia Piskin Sagir: None declared, Sema Yilmaz: None declared, Semral Gulcemal: None declared, Özgül Soysal Gündüz: None declared, Canberk Sami Başibüyük Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Serdar Alkan Employee of: employee and shareholder of Pfizer Inc., Istanbul, Turkey., Teoman Yusuf Cesur Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Fatos Onen: None declared

AB1088 COVID-19 VACCINATION OF SPONDYLOARTHRITIS PATIENTS RECEIVING BIOLOGICAL THERAPY: REAL-LIFE DATA

Background

Considering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged.

Objectives

Vaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed.

Methods

Adult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfizer-BioNTech) vaccine were included in our observational, multicenter, prospective study.

Results

A total of 287 patients (58.2% male; mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65; 22.6%) and DM (n:38; 13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sulfasalazine, and 12 (4.2%) patients were using leflunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infliximab (26.8%), adalimumab (23.3%) was the second (Table 1).

It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the first dose of vaccination is 11.5 days (5-19 IQR), between the first dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (p<0.001). While two of the patients who had COVID-19 infection in the pre-vaccination period required hospitalization, none of the patients who had COVID-19 in the post-vaccination period required hospitalization.

The rate of patients who developed side effects after the first dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically significant compared to inactivated virus vaccine in terms of both doses (p=0.011, p<0.001). Major side effects such as myocarditis, anaphylaxis-angioedema, myocardial infarction, and thrombosis were not observed in any of the patients included in the study. There was no evidence of disease activation in the median follow-up of 209 days (145-280 IQR) after vaccination.

Conclusion

During the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.

References

[1]Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 global rheumatology alliance vaccine survey. RMD Open. 2021;7(3):e001814.

[2]Shenoy P, Ahmed S, Paul A, et al. Inactivated vaccines may not provide adequate protection in immunosuppressed patients with rheumatic diseases. Ann Rheum Dis. 2021. doi:10.1136/annrheumdi s-2021-221496

Disclosure of Interests

None declared

AB1526-HPR AWARENESS ASSESSMENT IN PATIENTS USING SUBCUTANEOUSLY ADMINISTERED BIOLOGICAL AGENTS ABOUT DRUG UTILIZATION

Background

Subcutaneous biological agents (SCBA) are commonly used in rheumatologic disorders, their storage in appropriate conditions and correct administration have importance. Informing the patient adequately and correctly is essential. Storing the drug in inappropriate conditions reduces its effectiveness, and affects the response to treatment (1).

When these treatments are initiated, information on all the mentioned topics is provided to the patients, and they undergo hands-on training. Finally, the patients is requestioned in outpatient follow-up about whether a problem has occurred or not (2).

Objectives

This study aimed to investigate the awareness of patients using SCBA about the drug’s utilization and storage conditions.

Methods

Demographic data of 100 patients diagnosed with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, using SCBA who presented to our outpatient clinic between January 2021 and June 2021,were recorded, and survey questions were asked.

Results

One hundred patients (46 females-54 males) were included in the study. Sixty-one patients were diagnosed with ankylosing spondylitis, 20 patients with rheumatoid arthritis, and 19 with psoriatic arthritis. The patients’ mean age was 44.6±11.07 years. The mean duration of SCBA use was 74.5 (2-222) months.

The patients’ replies to the survey questions are summarized in Table 1. Most patients performed the injection themselves in both genders, whereas some women received help from paramedics (p=0.041). Forty percent of the patients with education level of high school or higher had a concern regarding drug use, whereas this rate was 21% in patients with education level of primary school. It was determined that the anxiety level decreased with decreasing level of education (p=0.032).

Table 1.

The patients’ replies to the survey questions

N=100n (%)Rate of patients who read the patient consent form before starting the drug88 (88)Concern regarding drug use23 (23)Malignancy7 (7)Increase in infection7 (7)Tuberculosis70 (70)Not worriedThe person who informing patients on drug use88 (88)Nurse18 (18)Doctor7 (7)NurseanddoctorPatients who were informed about when to interrupt drug use86 (86)Situations where drug use is suspended84 (95,3)Flu and febril infection68 (79,1)Use of antibiotics39 (45,3)Herpes simplex virus infectionDrug storage65 (65)Refrigerator shelf31 (31)Refrigerator door4 (4)PharmacyState of waiting before administering the drug17 (17)Don’t wait71 (71)20-30 minutes at room temperature6 (6)>30 minutes at room temperature5 (5)Hand warming and then administration1 (1)Soak in hot waterRate of controlling the expiration date before administering the drug64 (64)Rate of patients who control the clarity of the drug75 (75)Rate of hand washing before administering the drug83 (83)Injection site cleaning6 (6)Don’t clean66 (66)With the swab from the drug box24 (24)With alcohol3 (3)With a wet wipe1 (1)With soapThe person performing the injection84 (84)The person11 (11)Person’s relative5 (5)Health personelThe patients who carry their medication in accordance with the cold chain rules during travel71 (100)

It was observed that in patients who used multiple SCBA for a long time, taking the drug out of the refrigerator and applying it after waiting for the optimum time, controlling the expiration date of the drug and hand washing before the application decreased over time.

Conclusion

Evaluating the patient’s SCBA treatment background is essential for correct treatment practice. Our study revealed that in forming patients on drug use not only initially but also at certain intervals is essential.

References

[1]From therapeutic patient education principles to educative attitude: the perceptions of health care professionals – a pragmatic approach for defining competencies and resources. Patient Preference and Adherence 2017:11 603–617.

[2]Adherence to Subcutaneous Anti-TNF Treatment in Chronic Inflammatory Rheumatism and Therapeutic Patient Education. Patient Preference and Adherence 2020:14 363–369.

Disclosure of Interests

None declared

POS0792 PULMONARY ARTERY INVOLVEMENT IN BEHCET’S DISEASE: SINGLE CENTER RESULTS

Background

Behcet’s disease (BD) is a multisystem inflammatory vasculitis. Skin, mucosa, eye, vascular area, joint, gastrointestinal system and central nervous system involvement is observed.

Objectives

In this study, we aimed to present the data of patients with pulmonary artery involvement (PAI) followed up with the diagnosis of BD.

Methods

The clinical, demographic and laboratory data of 394 patients with the diagnosis of BD, who were followed up in our rheumatology outpatient clinic between 2000 and 2020, were evaluated retrospectively.

Results

Of the patients followed up with the diagnosis of BD, 44% were female and 56% were male. Oral aphthous ulcers were found in 96%, genital ulcers in 65%, papulopustular lesions in 33%, erythema nodosum in 38%, and pathergy positivity in 47% of the patients.

PAI was detected in 3% (n:13) of the patients who were followed up with a diagnosis of BD. 69% of the patients who had PAI were male, and their mean diagnosis age was 27±9, disease duration was 10±4.7 years. Pulmonary artery aneurysm was observed in 62%, pulmonary artery thrombosis (PAT) was observed in 85%, and both conditions were observed in 46% of the patients. Oral aphthous ulcer were found in all patients, genital ulcers in 70%, papulopustular lesions in 23%, pathergy positivity in 39%, and erythema nodosum in 23%. One of the patients with PAI had hereditary thrombophilia and also lower extremity deep vein thrombosis (DVT). Cardiac involvement was in the form of intracardiac thrombus in patients with PAI.

Patients with and without PAI were compared in terms of clinical findings. A significant difference was observed in terms of DVT in the lower extremity, venous and cardiac involvement. The relationship between PAI and these involvements was also shown in the regression analysis (Table 1).

Table 1.

Comparison of data of patients with and without pulmonary artery involvement

N (%)Pulmonary Artery Involvement (+)Pulmonary Artery Involvement (-)POR (%95 CI)*N=13N=381Gender Female4(30)168(44)0.341 Male13(70)213(56)Family History2(15)46(12)0.664Oral Aphthous Ulcer13(100)366(96)1Genital Ulcer9(70)247(65)1Papulopustular lesion3(23)126(33)0.559Erythema Nodosum3(23)147(39)0.385Pathergy positivity5(39)180(47)0.738Uveitis-138(36)NARetinal Vasculitis-11(3)NAArthritis1(8)97(26)0.200Venous Involvement8(62)68(18)0.0017.365(2.33-23.20)Lower Extremity Deep Venous Thrombosis6(46)46(12)0.0036.24(2.01-19.38)Peripheral Artery Aneurysm-5(1)NAGIS involvement-17(5)NACardiac involvement3(23)4(1)0.00138.27(5.57-143.25)Cranial Involvement-24(6)NA

*Significant data in logistic regression analysis were presented, GIS: Gastrointestinal system

Cranial involvement was not detected in any of our patients with PAI. In subgroup analysis, a significant relationship was observed between PAT and intracardiac thrombus (p=0.001 OR:21.05 95%CI 3.4-130) and lower extremity DVT (p=0.001 OR: 8.79 95%CI 2.58-29.96).

Conclusion

PAI is rare but the most important involvement affecting mortality in BD patients. Recently, there has been an increase in the incidence of isolated PAT with the contribution of the developments in imaging methods.1 PAI is associated with lower extremity DVT, cerebral venous thrombosis and intracardiac thrombus.2 In our study, a significant correlation was found between PAI and the presence of venous involvement, lower extremity DVT and intracardiac thrombus.

References

[1]Ozguler Y, Seyahi E. Behçet’s Disease: Vascular involvement. Seyahi E, editor. Behçet’s Disease 1st ed. Ankara .Turkiye Clinics; 2020.p 43-7

[2]Tascilar K, Melikoglu M, Ugurlu S, Sut N, Caglar E, Yazici H. Vascular involvement in Behçet’s syndrome: a retrospective analysis of associations and the time course. Rheumatology (Oxford). 2014 Nov;53(11):2018-22

Disclosure of Interests

None declared

AB0821 The frequency of lumbosacral transitional vertebras in patients with ankylosing spondylitis

Background

Lumbosacral transitional vertebras (LSTVs) are anatomic variations observed at L5-S1 junction (1). The prevalence of LSVT ranges from 3.9% to 35.6%, indicating that this congenital anomaly is common in general population. LSVTs are well-defined anatomical differences causing low back pain and pelvic trauma (2). However, the studies assessing the influence of abnormal lumbosacral anatomy on low back pain and sacroiliac joints in patients with ankylosing spondylitis (AS) are scarce (3).

Objectives

The current study aimed to investigate the frequency of LSVTs and the their effects on clinical variables in AS patients.

Methods

The study was designed as a prospective cross-sectional study. 113 patients were included in the study. Demographic data, clinical variables, laboratory results were recorded. Disease activity (ASDAS-CRP and ASDAS-ESR), patients’ functionality (BASFI, BASMI), enthesitis (Leeds enthesitis index) and quality of life (SF-36, visual analogue scale) were evaluated. The baseline pelvic conventional radiographs and the sacroiliac magnetic resonance imaginings at the diagnosis were screened and assessed by two independent physicians. LSTVs were classified via Castellvi classification. Kappa coefficient was used to find the interobserver reliability.

Results

LSVTs were observed in 38 (33.6%) patients. Castellvi type Ia, Ib, IIa, IIb, IIIa, IIIb, and IV were found in 10 (8.8%), 7 (6.2%), 7 (6.2%), 6 (5.3%), 4 (3.5%), 1 (0.9%), and 3 (2.7%) patients, respectively. The kappa value for interobserver reliability was 0.69. There were not any differences between AS patients with and without LSVTs in terms of disease activity, functionality, and quality of life (Table 1). No statistically significant correlation was found between LSVTs identified by conventional radiography and sacroiliitis determined by MRI. When compared the patients according to Castellvi classification, visual analogue scale was higher in patients with IIIa than in patients with IV (p=0.013). Disease duration was longer in patients with Ib than in patients with Ia (p=0.029). ASDAS-CRP and ASDAS-ESR were higher in patients with IIIa than in patients with IV (p=0.008 and p=0.007).

Table 1.

The comparison of clinical characteristics between patients with and without LSVTs

Patients without LSVTs (n=75)Patients with LSVTs (n=38)pVAS3.0 (2.0−5.0)3.4 (1.0−6.0)0.734Disease duration (month)122.0 (60.0−180.0)120.0 (57.0−183.0)0.834ASDAS-CRP1.8 (1.2−2.5)1.8 (1.2−2.9)0.855ASDAS-ESR1.6 (1.2−2.5)1.6 (1.0−2.7)0.976CRP1.8 (0.8−5.3)2.5 (1.0−6.1)0.471BASMI2.9 (2.0−4.4)3.0 (2.1−4.0)0.796BASFI1.8 (0.7−4.6)2.1 (0.7−3.0)0.768SF-36Physical function80.0 (55.0−95.0)80.0 (63.8−95.0)0.765Role physical45.6 (0−100.0)50.0 (25.0−100.0)0.280Role emotional66.7 (0−100.0)33.0 (0−100.0)0.267Energy/fatigue50.0 (35.0−70.0)60.0 (38.8−71.3)0.201Mental health64.0 (48.0−76.0)68.0 (52.0−80.0)0.330Social functioning62.5 (50.0−87.5)75.0 (50.0−100.0)0.252Body pain67.5 (45.0−80.0)67.5 (45.0−90.0)0.751General health45.0 (35.0−65.0)50.0 (40.0−71.3)0.411

Values are given as median (interquartile range)

Conclusion

In AS patients, the frequency of LSVT is 33.6%, which is consistent with the general population. Type I, also known as a dysplastic transverse process, is the most observed type of LSVT. The presence of LSVTs is associated neither with clinical variables nor with sacroiliitis.

References

[1]Heaps BM, Feingold JD, Swartwout E, et al. Lumbosacral Transitional Vertebrae Predict Inferior Patient-Reported Outcomes After Hip Arthroscopy. Am J Sports Med. 2020;48(13):3272-3279

[2]Matson DM, Maccormick LM, Sembrano JN, Polly DW. Sacral Dysmorphism and Lumbosacral Transitional Vertebrae (LSTV) Review. Int J Spine Surg. 2020;14(Suppl 1):14-19. Published 2020

[3]Carvajal Alegria G, Voirin-Hertz M, Garrigues F, et al. Association of lumbosacral transitional vertebra and sacroiliitis in patients with inflammatory back pain suggesting axial spondyloarthritis. Rheumatology (Oxford). 2020;59(7):1679-1683.

Disclosure of Interests

None declared

AB0794 Hopelessness in patients with ankylosing spondylitis

Background

Ankylosing spondylitis (AS) is a chronic inflammatory disease leading to loss of function that is strongly related to impaired psychological status. Therefore, depression and anxiety are frequently investigated in these patients (1). However, hopelessness, regarded as a valuable psychological factor characterized by negative expectations and negative emotional states, was not well studied in AS patients(2).

Objectives

The aim of the study is to investigate the frequency of hopelessness in patients with AS and its relationship with clinical parameters and disease activity indices.

Methods

The study was designed as a prospective cross-sectional study. 113 AS patients were included in the study. Demographic data, clinical variables, laboratory results were recorded. Disease activity (ASDAS-CRP and ASDAS-ESR), patients’ functionality (BASFI, BASMI), enthesitis (Leeds enthesitis index) and quality of life (SF-36) were assessed. Hopelessness was evaluated by Beck hopelessness scale (BHS). The relation of BHS scores with the clinical variables was assessed. The strength of the correlations were regarded as very weak(0–0.19), weak(0.2–0.39), moderate(0.40–0.59), strong(0.6–0.79) and very strong(0.8-1). Multiple linear regression analysis was performed to find the association between BHS scores and other clinical variables.

Results

Minimal, mild, moderate, and severe hopelessness were observed in 46 (40.7%), 36 (31.9%), 22 (19.5%), and 9 (8.0%) patients, respectively. Disease duration (p=0.025), ASDAS-CRP (p=0.033), ASDAS-ESR (p=0.015), visual analogue scale (p=0.030), all SF-36 subscales (all p<0.025), BASFI (p=0.024), and BASMI (p=0.009) were statistically different among the groups. BHS scores were higher in patients with high and very high disease activity (p=0.027) (in pairwise comparison, inactive disease vs. high disease activity, p=0.035) (Figure 1). BHS scores showed weak correlation with ASDAS-CRP, ASDAS-ESR, visual analogue scale, BASMI, Leeds enthesitis index, and BASFI. Moreover, negative moderate correlations were detected between BHS scores and SF-36 subscales except social functioning and body pain, which were found weak correlation. In multiple linear regression analysis, BASMI-maximal intermalleolar distance, SF-36 energy, SF-36 mental health, and SF-36 general health were found associated with BHS scores (Table 1).

Table 1.

Multiple linear regression analysis to find predictors related to the Beck hopelessness scale scores

B95% CIpASDAS-CRP-0.063(-1.939) to 1.2820.687VAS-0.085(-0.722) to 0.3960.564BASMILateral spinal flexion0.311(-0.299) to 1.4790.191Tragus to wall distance0.157(-0.404) to 1.6020.239Modified Schober0.298(-0.114) to 1.3680.096Maximal intermalleolar distance0.2280.076 to 0.5570.010Cervical rotation0.092(-0.665) to 1.0850.635Total-0.730(-5.572) to 1.0420.177SF-36Physical function-0.024(-0.056) to 0.0460.840Role physical-0.114(-0.046) to 0.0170.364Role emotional-0.019(-0.029) to 0.0240.870Energy/fatigue-0.283(-0.125) to (-0.005)0.035Mental health-0.306(-0.142) to (-0.022)0.008Social functioning0.022(-0.033) to 0.0410.822Body pain0.182(-0.018) to 0.0860.192General health-0.344(-0.125) to (-0.030)0.002BASFI-0.085(-0.606) to 0.2480.408Figure 1.

Beck hopelessness scale scores according to disease activity subgroups

Conclusion

Higher level of hopelessness is strongly related to higher disease activity in AS patients. Furthermore, higher BHS scores are negatively correlated with SF-36 subscales. Especially, lower energy and impaired mental health are associated with higher level of hopelessness.

References

[1]Zhang L, Wu Y, Liu S, Zhu W. Prevalence of Depression in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Psychiatry Investig. 2019;16(8):565-574. doi:10.30773/pi.2019.06.05

[2]Balsamo M, Carlucci L, Innamorati M, Lester D, Pompili M. Further Insights Into the Beck Hopelessness Scale (BHS): Unidimensionality Among Psychiatric Inpatients. Front Psychiatry. 2020;11:727. Published 2020 Jul 31. doi:10.3389/fpsyt.2020.00727

Disclosure of Interests

None declared

POS0001 CAN SINGLE IMPUTATION TECHNIQUES FOR BASDAI COMPONENTS RELIABLY CALCULATE THE COMPOSITE SCORE IN AXIAL SPONDYLOARTHRITIS PATIENTS?

Background

In axial spondyloarthritis (axSpA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a key patient-reported outcome. However, one or more of its components may be missing when recorded in clinical practice.

Objectives

To determine whether an individual patient’s BASDAI at a given timepoint can be reliably calculated with different single imputation techniques and to explore the impact of the number of missing components and/or differences between missingness of individual components.

Methods

Real-life data from axSpA patients receiving tumour necrosis factor inhibitors (TNFi) from 13 countries in the European Spondyloarthritis (EuroSpA) Research Collaboration Network were utilized [1]. We studied missingness in BASDAI components based on simulations in a complete dataset, where we applied and expanded the approach of Ramiro et al. [2]. After introducing one or more missing components completely at random, BASDAI was calculated from the available components and with three different single imputation techniques: possible middle value (i.e. 50) of the component and mean and median of the available components. Differences between the observed (original) and calculated scores were assessed and correct classification of patients as having BASDAI<40 mm was additionally evaluated. For the setting with one missing component, differences arising between missing one of components 1-4 versus 5-6 were explored. Finally, the performance of imputations in relation to the values of the original score was investigated.

Results

A total of 19,894 axSpA patients with at least one complete BASDAI registration at any timepoint were included. 59,126 complete BASDAI registrations were utilized for the analyses with a mean BASDAI of 38.5 (standard deviation 25.9). Calculating BASDAI from the available components and imputing with mean or median showed similar levels of agreement (Table 1). When allowing one missing component, >90% had a difference of ≤6.9 mm between the original and calculated scores and >95% were correctly classified as BASDAI<40 (Table 1). However, separate analyses of components 1-4 and 5-6 as a function of the BASDAI score suggested that imputing any one of the first four BASDAI components resulted in a level of agreement <90% for specific BASDAI values while imputing one of the stiffness components 5-6 always reached a level of agreement >90% (Figure 1, upper panels). As expected, it was observed that regardless of the BASDAI component set to missing and the imputation technique used, correct classification of patients as BASDAI<40 was less than 95% for values around the cutoff (Figure 1, lower panels).

Table 1.

Level of agreement between the original and calculated BASDAI and correct classification for BASDAI<40 mm

Level of agreement with Dif≤6.9 mm* (%)Correct classification for BASDAI<40 mm** (%)1 missing componentAvailable93.996.9Value 5073.996.3Mean94.296.8Median93.196.82 missing componentsAvailable83.794.8Value 5040.792.8Mean83.594.8Median82.894.73 missing componentsAvailable71.992.6Value 5028.187.3Mean72.292.6Median69.792.2

* The levels of agreement with a difference (Dif) of ≤6.9 mm between the original and calculated scores were based on the half of the smallest detectable change. Agreement of >90% was considered as acceptable. ** Correct classification of >95% was considered as acceptable.

Figure 1.

Level of agreement between the original and calculated BASDAI and correct classification for BASDAI<40 mm as a function of the original score

Conclusion

BASDAI calculation with available components gave similar results to single imputation of missing components with mean or median. Only when missing one of BASDAI components 5 or 6, single imputation techniques can reliably calculate individual BASDAI scores. However, missing any single component value results in misclassification of patients with original BASDAI scores close to 40.

References

[1]Ørnbjerg et al. (2019). Ann Rheum Dis, 78(11), 1536-1544.

[2]Ramiro et al. (2014). Rheumatology, 53(2), 374-376.

Acknowledgements

Novartis Pharma AG and IQVIA for supporting the EuroSpA collaboration.

Disclosure of Interests

Stylianos Georgiadis Grant/research support from: Novartis, Myriam Riek Grant/research support from: Novartis, Christos Polysopoulos Grant/research support from: Novartis, Almut Scherer Grant/research support from: Novartis, Daniela Di Giuseppe: None declared, Gareth T. Jones Speakers bureau: Janssen, Grant/research support from: AbbVie, Pfizer, UCB, Amgen, GSK, Merete Lund Hetland Grant/research support from: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Merck, Celgene, Novartis, Simon Horskjær Rasmussen Grant/research support from: Novartis, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Bente Glintborg Grant/research support from: Pfizer, Abbvie, BMS, Anne Gitte Loft Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Karel Pavelka Speakers bureau: Pfizer, MSD, BMS, UCB, Amgen, Egis, Roche, AbbVie, Consultant of: Pfizer, MSD, BMS, UCB, Amgen, Egis, Roche, AbbVie, Jakub Zavada Speakers bureau: Abbvie, Elli-Lilly, Sandoz, Novartis, Egis, UCB, Consultant of: Abbvie, Elli-Lilly, Sandoz, Novartis, Egis, UCB, Merih Birlik: None declared, Ayten Yazici Grant/research support from: Roche, Brigitte Michelsen Grant/research support from: Novartis, Eirik kristianslund: None declared, Adrian Ciurea Speakers bureau: AbbVie, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Consultant of: AbbVie, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Michael J. Nissen Speakers bureau: AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Consultant of: AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Ana Maria Rodrigues Speakers bureau: Abbvie, Amgen, Consultant of: Abbvie, Amgen, Grant/research support from: Novartis, Pfizer, Amgen, Maria Jose Santos Speakers bureau: Abbvie, AstraZeneca, Lilly, Novartis, Pfizer, Gary Macfarlane Grant/research support from: GSK, Anna-Mari Hokkanen Grant/research support from: MSD, Heikki Relas Speakers bureau: Abbvie, Celgene, Pfizer, UCB, Viatris, Consultant of: Abbvie, Celgene, Pfizer, UCB, Viatris, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Corina Mogosan: None declared, Ziga Rotar Speakers bureau: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Consultant of: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz-Lek, Consultant of: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz-Lek, Björn Gudbjornsson Speakers bureau: Amgen, Novartis, Consultant of: Amgen, Novartis, Arni Jon Geirsson: None declared, Pasoon Hellamand Grant/research support from: Novartis, Marleen G.H. van de Sande Speakers bureau: Eli Lilly, Novartis, UCB, Janssen, Abbvie, Consultant of: Eli Lilly, Novartis, UCB, Janssen, Abbvie, Grant/research support from: Eli Lilly, Novartis, UCB, Janssen, Abbvie, Isabel Castrejon: None declared, Manuel Pombo-Suarez Consultant of: Abbvie, MSD, Roche, Bruno Frediani: None declared, Florenzo Iannone Speakers bureau: Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis

AB0762 Incidence Of Anterior Uveitis In Axial Spondyloarthritis During Secukinumab Treatment: TWO YEARS REAL LIFE EXPERIENCE FROM TURKBIO REGISTRY

Background

Secukinumab (SEC), a human anti-IL-17A monoclonal antibody, has similar treatment response rates to tumor necrosis factor (TNF) inhibitors in patients with axial spondyloarthritis (SpA). However, the efficacy of SEC on anterior uveitis (AU) is unclear.

Objectives

This study aimed to evaluate the risk of new-onset or relapsing AU in axial SpA patients treated with SEC.

Methods

In this prospective cohort study, 130 axial SpA patients receiving SEC at the TURKBIO registry between 2019 and 2021 were evaluated. Demographic and clinical characteristics and data about the presence of AU pre or post-treatment were collected. The univariate and multivariate logistic regression analyses were performed to evaluate the predictors of AU development.

Results

The mean age of the patients (F/M: 59/71) was 47.4±10.9 years. The median follow-up time was 540 days (IQR: 330-630). SEC was the first biological agent in 50 (38.4%) patients and 35 (26.9%) patients were using at least one concomitant conventional synthetic DMARD (Table 1). While continued SEC therapy was in 93 (71.5%) patients, treatment withdrawal was in 37 cases (in 26 due to ineffectiveness, two adverse events and nine other reasons). Overall, 15(11.5%) patients had a history of AU before the SEC. During follow-up, AU attacks were seen in the 6 cases (4 were new-onset and 2 were flare) and 5 of these patients have a history of inadequate response to TNF inhibitors. The frequency of AU was calculated as 3.42 per 100 patient-years during SEC treatment. The only significant predictor of AU development was the baseline high C-reactive protein (CRP) level on multivariate analysis (p=0.003, OR: 1.063 [95% CI 1.021-1.107]).

Table 1.

Demographics and clinical characteristics of the patients

Total (n:191)Gender (F/M)59/71Age (years) (mean±SD)47.4±10.9Diagnosis; n (%)   AS125 (96.2)   nr-axSpA5 (3.8)BASDAI (mean±SD)47.2±20.48   Missing n (%)4 (3.07)ASDAS (mean±SD)3.32±0.92   Missing n (%)14 (10.7)C-reactive protein (mg/L) median (IQR)12.6 (4.67-22.62)Sedimentation (mm/h) median (IQR)22 (9-42)Concomitant csDMARDs n (%)35 (26.9)Secukinumab dose n (%)   150 mg120 (92.3)   300 mg10 (7.7)TNFi-naive patients n (%)50 (38.5)Number of previous bDMARDs n (%)   136 (27.7)   223 (17.7)   ≥ 321 (16.1)History of previous TNFi n (%)   Monoclonal TNFi64   Etanercept16

AS; Ankylosing spondylitis, nr-axSpA; Non radiographic axial spondyloarthritis, BASDAI; Bath Ankylosing Spondylitis Disease Activity Index, ASDAS; Ankylosing Spondylitis Disease Activity Score, csDMARD; conventional synthetic disease modifying anti-rheumatic drug, TNFi; Tumor necrosis factor inhibitors, bDMARD; biological DMARD. Datas were expressed as number (%), mean±SD or median (IQR).

Conclusion

In this real-life data from the TURKBIO registry, the incidence of AU in axial SpA patients treated with SEC was calculated as 3.42 per 100 patient-years. A high baseline CRP level was an independent factor for developing AU.

Disclosure of Interests

None declared